Scorecard: What The Health Law Has Delivered, Or Not

While many of the most significant provisions of the 2010 health law don’t take effect until 2014, some key changes have kicked in since Congress approved it two years ago. Kaiser Health News consulted the agencies implementing the law to track how some of these new programs are going, and compared that data to the original projections of the nonpartisan Congressional Budget Office and the Obama administration. Much of the available data covers a limited period — usually through the end of 2011 or the fiscal year ending Sept. 2011.

Insuring young adults provision requires private insurers to extend coverage of children until age 26, effective Sept. 23, 2010, regardless of their tax status or whether they are students, unless he or she has another offer of employer-based coverage.

Cost: An average 1.5 percent premium increase for those covered in a group plan in 2011. [HHS]

An estimated 54 million people received at least one free preventive health benefit in 2011. [HHS]

Cost: Estimated 0.4 percent increase in 2011 premiums for those covered in a group plan. [Commonwealth Fund]

Seniors’ Benefits

Rebates for prescription drugs, in the form of a one-time, tax-free payment of $250, were sent to Medicare Part D beneficiaries for drugs purchased in 2010 when they reached the coverage gap, or “doughnut hole.”

An estimated 32.5 million seniors received at least one free preventive benefit in 2011. [HHS]

Cost: Not Available

Consumer Protections

Proposed premium rate increases of 10 percent or higher for individual or small group plans must be justified to state or federal reviewers beginning in September, 2011 for plans issued after March 23, 2010. Regulators in 37 states can reject a requested increase. If a state has no review authority, federal regulators can step in. However, federal officials can ask, but not require an insurer to reduce a proposed hike.

Law provides $250 million to states to strengthen their rate review processes. [HHS]

42 states and the District of Columbia have received grants of $157 million to develop or improve premium review [KHN interview]. At least five states have forced insurers to reduce proposed premium increases, and federal officials say fewer insurers have proposed double-digit rate increases since the provision went into effect. [HHS]

Insurers must spend at least 80 percent of beneficiaries’ premiums on medical care or health quality improvements. “Mini-med” plans that offer limited benefits have a one-year exemption. Self-insured employers, which pay claims directly instead of through an insurance company, are not covered.

Approximately 74.8 million privately insured Americans affected. As many as 9 million people who buy individual policies are projected to receive rebates worth up to $1.4 billion by Aug. 1. [HHS]

Insurers will report data for the first time in June showing whether they’ve met the new standard, called a medical loss ratio. Those plans that fail to do so must pay rebates to individual policyholders by Aug. 1, unless they operate in the eight states that received temporary exemptions. Plans selling group insurance must deliver rebates to the policyholder — in most cases, the employer – and can do so in the form of lower premiums.

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Scorecard: What The Health Law Has Delivered, Or Not

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